that log CA 19-9 kinetics was a significant predictor of both time to tumor progression (Hazard Ratio, HR 1.48, P<0.001) and overall survival (HR 1.34, P<0.001) (66). Utility of CA 19-9 serum levels to predict post-operative recurrence The predictive value of current methods (CT scan and PET scan) to assess early post-operative recurrence is sub-optimal given that pancreatic resection is often associated with intense desmoplastic and post-operative inflammatory changes leading to dense fibrosis making radiological detection difficult (15,41,60). The utility of sequential post-operative CA 19-9 serum level measurement to detect early recurrence in pancreatic cancer patients has been well studied. Kang et al.